Hypoalbuminemia and the Higher Risk of Perioperative Sentinel Adverse Events in Patients Undergoing Total Shoulder Arthroplasty: A Propensity Score Matched Analysis

Document Type : RESEARCH PAPER


Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, USA


Background: The purpose of this study is to examine the effect of hypoalbuminemia (HA) on sentinel adverse events
after total shoulder arthroplasty (TSA).
Methods: Patients who underwent primary TSA from 2015-2018 were collected from the National Surgical Quality
Improvement Program (NSQIP) database. Patients with HA (serum albumin < 3.5 g/dL) were compared to patients with
normal serum albumin. A probit regression model was used to estimate a propensity score. Logistic regression was
performed to evaluate the effect of HA on sentinel adverse events after surgery.
Results: A total of 4,337 patients were included, 8.2% of patients had HA. Patients with HA had higher rates of
sentinel adverse events (14.0% vs 5.5%, P<0.01) compared with patients who had normal serum albumin. Reoperation
(4.5% vs 1.5%, P<0.01), readmission (11.2% vs 3.9%, P<0.01), urinary tract infection (0.8% vs 0.03%, P<0.01) and
pulmonary embolism (1.1% vs 0.2%, P=0.01) were higher in patients with HA. The odds ratio for a sentinel event for
patients with HA was 2.6 (95% CI: 1.54, 4.44, P<0.01) when compared to a propensity score-matched control group.
Conclusion: Patients with HA are at increased risk of sentinel adverse events following TSA compared to patients with
normal serum albumin levels.
Level of evidence: II


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